Question

You are assessing a 68-year-old male patient who was brought to the ED by his wife after he fainted in the bathroom. He is lying supine with his knees slightly flexed complaining of severe pain in his upper abdomen, dizziness and nausea.

Assessment Findings

Mental Status:                         Awake and obeys commands, GCS 15

Breathing:                                  RR 18, non-labored, shallow, SpO2 94%/ RA. Lungs are clear and equal bilateral.

                  He states that if he takes a deep breath it makes his stomach pain worse.

Circulation:                                 Skin is pale and cool. Radial pulse is 98 and regular, dorsal pedis pulses are

                                                      weak and thready. Blood pressure is 110/78 and he has positive orthostatics

                                                      (blood pressure 90/66 and pulse 120).

Assessment:                             Abdomen is rigid but not distended, pain is present in upper quadrants 9/10

                                                      worse with movement and palpation. He states that even breathing hurts.

                                                      Bowel sounds are present.

Other Findings:                        Temperature 39.7 C

History

Events:                                        He states he has not felt like eating much the past few days and has had vague

                                                      burning pain in his left upper quadrant and. He states he has been nauseated

                                                      but has not had any vomiting. Last night the abdominal pain suddenly got

                                                      worse becoming more severe and sharp. This morning he was getting ready to

                                                      go see his doctor when he passed out in the bathroom.

Previous Illness:                        Angina, Osteoarthritis

Medications:                             Aspirin, nitroglycerin, vitamin E, Glucosamine, Ginkgo, Ginseng

1. Given the information above what other information specific to the GI system and this patient’s presentation would you ask about?
2. What are possible cause of this patient’s current condition?
3. What is the relationship between the patient’s current condition and his medication history?
4. What is the significance of positive orthostatic changes?
5. What is the significance of the patient’s temperature of 39.7C and how does it relate to his current condition?

Answer 1

●Some of the other information which can be asked in regards to the gastrointestinal system are

• Belching (to rule out acid reflux)
• Whether the pain radiating to back ( one of the sign of gastritis)
• Foul smelling stool or blood in stool (can be due to gastrointestinal ulceration)
• Abdominal distention (to assess for any growth)

●The possible cause of the patient's current condition is due to gastritis. (The patient exhibits symptoms of pain in upper abdomen, nausea,fever ,loss of appetite, tachycardia,dizziness)

●The main relationship between the current condition and the medication history are

• Aspirin usage can lead to gastrointestinal problems specifically
• The use of nitroglycerin can aggravate the dizziness, further lower the blood pressure, orthostatic hypotension
• Glucosamine,gingko, ginseng can increase the risk for bleeding when taken along with aspirin

●A positive orthostatic hypotension refers to "when a patient gets up from sitting or lying down position, the patient will experience dizziness, imbalance due to sudden drop in blood pressure "

The significance of this sign indicates that this is the side effects of nitroglycerin

●A temperature of 39.7 C is a clear indicator of some infection, inflammation to fight against it the immune system has responded. An extreme stage of gastritis leads to elevated body temperature.